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Play It Through

Dramatherapy: one of the Allied Health Professions

As a dramatherapist I am an Allied Health Professional (AHP): This mean I am one of a collection of 14 occupations representing the third largest clinical workforce in health and social care in England (after “medical and dental” and “nursing and midwifery”) and the third largest group employed by the NHS.

The 14 AHP occupations are:

  1. Art therapists (for mental health)
  2. Dramatherapists (for mental health)
  3. Music therapists (for mental health)
  4. Chiropodists/podiatrists (for feet)
  5. Dietitians (for food and weight)
  6. Occupational therapists (for self-care, productivity & leisure)
  7. Operating Department Practitioners (for surgery)
  8. Orthoptists (for eyes)
  9. Osteopaths (for joints, muscles and spine)
  10. Paramedics (for emergencies e.g. in an ambulance)
  11. Physiotherapists (for movement)
  12. Prosthetists and Orthotists (for missing or broken limbs)
  13. Radiographers (for scanning and imaging tests e.g an X-ray or CT scan)
  14. Speech and language therapists (for communication)

Many of these roles have a particular focus on patient well-being. For example, if you are getting ready for surgery the anaesthetic nurse has a job to make sure you have enough medicine to keep you unconscious without making you ill, but the Operating Department Practitioner (an AHP) has a main job to talk to you so that as you fall unconscious you are calm; this is really important because if you are in a state of hyper-arousal (panic or fight, flight, freeze) when you fall to sleep you are likely to wake up still in that same state and this can have a big impact on your recovery or your likely-hood of developing PTSD from the surgery. So those pre-surgery questions asking you about your day or inviting you to count back from 10 are really important.

The dietitian AHP needs to understand your relationship with food and something about your lifestyle in order to recommend a diet which might work. This is not as simple as just recommending an apple a day, it is really getting to know the particular needs of this client; perhaps how their medications or illnesses impact on their food intake, perhaps on how allergies reduce some food choices, perhaps how their weight goals impact on their diet. It’s also supporting patients to maintain a healthy diet or to make adjustments and try again when something may not have worked previously.

A speech and language therapist AHP may work with a young child who has a delay in learning language or may work with someone who has lost speech after a head trauma or stroke. It is building relationships and offering exercises and techniques to learn words and to use the muscles around the mouth, tongue and throat.

This is not to imply that other medical roles do not also listen to patients and focus on those relationships; your GP for example, should absolutely be doing that as well. Your GP may offer you a 10 minute appointment, where they are listening out for cues to tell them what to prescribe or who to refer you to. An AHP might spend a little longer building that relationship and asking more personal questions about you to tailor their approach to your needs.

It may seem unusual that the three arts therapies are part of this group, particularly when other types of counselling, psychotherapy, psychiatry and psychology are not. This is partially because art therapy, dramatherapy and music therapy are all protected titles (as all AHP titles are) requiring state registration with the HCPC, this makes us different from our BACP and UKCP regulated colleagues in the talking therapies and other mental health practitioners.

Let’s explore some of the other words associated with AHPs and how dramatherapy in particular is involved in that:

Active

AHP’s “are active in treatment and rehabilitation and they promote self-help and independence.”

(From https://www.hee.nhs.uk/our-work/allied-health-professions, accessed 18/11/2019).

There is a physical element of the arts therapies when compared with some of the talking therapies – it is not just sitting or lying and talking, it is creating and doing and exploring. One of the definitions of drama is action, dramatherapy is literally doing healing. This activity is not something which is done “to” or “for” the client; the clients themselves are offered a chance to be active in their own healing journey.

Holistic

“Through adopting an holistic approach to healthcare, AHPs are able to help manage patients’ care throughout the life course from birth to palliative care.”

(From https://www.england.nhs.uk/ahp/about/, accessed 18/11/2019).

Many courses in counselling and psychotherapy will ask you to specify if you want to train to work with children or adults or families, for many courses you may not be allowed to count client hours with clients of a different age. In dramatherapy, we are taught to work with all ages, learning about the earliest establishment of infant relations pre-birth through neuro-dramatic play (Sue Jennings), through to different models of human development, relationships, mental disorders, profound and multiple learning needs and cognitive function, right through to end of life care. I am qualified to work with all ages, and have skills to work with non-verbal clients, as well as working creatively with clients who may be referred to my talking therapy colleagues for trauma or mental ill health.

We are also holistic as we see the whole person – the thoughts, the feelings, the body sensations, the spiritual, the relationships and community they are part of. Sometimes physical pain such as a headache or an upset tummy may link to increased stress or unexpressed anger. Sometimes anxiety or social isolation may link to trauma and a lack of safety. Sometimes numbness or heaviness may be linked to not seeing any meaning or purpose in life. Seeing the way that mental health and physical health can overlap allows us to offer ways of working which engage the whole person rather than segmenting off different aspects such as only focusing on the behaviour or on the thoughts.

Meaningful Goals

“Allied health professionals support people to reach goals that are meaningful to them, and its great to know that you are making such a difference to their quality of life.”

NHS Central London Clinical Healthcare, (2018-2020) Clinical Workforce Strategy: Towards 2023: Future proofing our clinical workforce. Page 19.

One of my favourite assessment tools is Psyclops – developed by a dramatherapist to invite clients to set their own goals and measure their progress against these. Success or health or quality of life may not look the same for everyone so it is about personalising this for each client and allowing them to define the path for therapy.

Evidence Based

“AHPs as being instrumental in delivering person-centred, evidence-based care as clinical leaders and practitioners. “

(From https://www.hee.nhs.uk/our-work/allied-health-professions, accessed 18/11/2019).

As a dramatherapist I try to read widely and attend regular CPD training on areas related to my work. I am also working towards publishing some of the work I am doing in Case Studies which can be shared with other professionals. This is always done with sensitivity to maintain client confidentiality and must have full informed client consent, but sharing best practice helps others in the field.

Some of what I write on this blog is to share ideas and developments, although as it is for the public I am careful not to reveal client details here. Within the next two years I would like to publish in a professional, peer reviewed journal such as Dramatherapy or The Arts in Psychotherapy so that I can add to the evidence base of the profession.

I am proud to be an allied health professional, one small part of a large group, of inspirational people who are helping patients and clients to improve their health and well-being.

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